The purpose of this project is to study the effectiveness of case management services in the mental health system of care for children in two counties of Western North Carolina. These counties (and the state of North Carolina) are one of eight sites selected to be funded by the Robert Wood Johnson Foundation to provide innovative mental health systems changes. The specific project in Western North Carolina includes the provision of a continuum of care, including case management services as well as other home/community based services, to serious emotionally disabled children who are in out of home placements or at risk of being placed. The study will be a randomized controlled trial which allocates clients from Buncombe and Haywood counties who participate in the RWJ program to a multiagency service team with a designated case manager (experimental condition) or to a multiagency service team without a designated case manager (control condition). Client level data will be collected through interviews at baseline, six and twelve months following entry into the study. This study will measure changes in clients on several levels: patient functioning, clinical status, out-of-home placements, family impact. Cost-effectiveness of services will also be analyzed. As part of a process evaluation activities of the individual case managers and team case management models will be assessed to determine quantity and type of activities performed in the two models of case management. This data will be collected through staff logs and management information systems data collection mechanisms. In addition, the functioning of county-level 'interagency councils' and services coordination patterns in the broader interorganizational network surrounding the demonstration program will also be examined over the course of the study.